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Helander L, McKinney C, Kelly K, Mack S, Sanders M, Gurley J, Dumont LJ, Annen K. Chronic granulomatous disease and McLeod syndrome: Stem cell transplant and transfusion support in a 2-year-old patient—a case report. Front Immunol 2022; 13:994321. [PMID: 36081507 PMCID: PMC9445126 DOI: 10.3389/fimmu.2022.994321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/02/2022] [Indexed: 11/21/2022] Open
Abstract
Chronic granulomatous disease (CGD) with McLeod neuroacanthocytosis syndrome (MLS) is a contiguous gene deletion disorder characterized by defective phagocytic function and decreased Kell antigen expression. CGD cure is achieved through hematopoietic stem cell transplant (HSCT) usually in the peri-pubescent years. The presence of MLS makes peri-transfusion support complex, however. Herein, we present the youngest known case of HSCT for CGD in the setting of MLS. A 2-year-old male patient was diagnosed with CGD plus MLS. Due to the severity of the child’s systemic fungal infection at diagnosis, HSCT was deemed the best treatment option despite his small size and age. A related, matched donor was available, and a unique red blood cell support plan had been implemented. Reduced-intensity conditioning was used to reduce the transplant-related mortality risk associated with myeloablative protocols. The transplant course was uneventful; autologous red blood cell (RBC) transfusion support was successful and allowed for the avoidance of possible antibody formation if allogeneic units had been used. The patient achieved 1-year relapse-free survival. The developed protocols provide a viable path to transplant in the very young, and early transplant to cure could reduce disease-related morbidity.
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Affiliation(s)
- Louise Helander
- ClinImmune Cell and Gene Therapy, Department of Medicine, University of Colorado Anschutz School of Medicine, Denver, CO, United States
- Transfusion Medicine and Apheresis, Department of Pathology, Children’s Hospital Colorado, Denver, CO, United States
- *Correspondence: Louise Helander,
| | - Chris McKinney
- Blood and Marrow Transplant Therapy Program, Children’s Hospital Colorado, Denver, CO, United States
| | - Kathleen Kelly
- Vitalant Research Institute, Vitalant, Denver, CO, United States
| | - Samantha Mack
- Vitalant Research Institute, Vitalant, Denver, CO, United States
- Department of Pathology, University of Colorado Anschutz School of Medicine, Denver, CO, United States
| | - Mary Sanders
- Transfusion Medicine and Apheresis, Department of Pathology, Children’s Hospital Colorado, Denver, CO, United States
| | - Janice Gurley
- Transfusion Medicine and Apheresis, Department of Pathology, Children’s Hospital Colorado, Denver, CO, United States
| | - Larry J. Dumont
- Vitalant Research Institute, Vitalant, Denver, CO, United States
- Department of Pathology, University of Colorado Anschutz School of Medicine, Denver, CO, United States
| | - Kyle Annen
- Transfusion Medicine and Apheresis, Department of Pathology, Children’s Hospital Colorado, Denver, CO, United States
- Department of Pathology, University of Colorado Anschutz School of Medicine, Denver, CO, United States
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2
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Kelly K, Helander L, Hazegh K, Stanley C, Moss R, Mack S, Sanders ML, Gurley J, McKinney C, Dumont LJ, Annen K. Cryopreservation of rare pediatric red blood cells for support following bone marrow transplant. Transfusion 2022; 62:954-960. [DOI: 10.1111/trf.16878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 12/01/2022]
Affiliation(s)
| | - Louise Helander
- ClinImmune Labs/Department of Medicine University of Colorado Aurora Colorado USA
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
| | | | | | | | | | - Mary L. Sanders
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
| | - Janice Gurley
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
| | - Chris McKinney
- Center for Cancer and Blood Disorders Children's Hospital Colorado Aurora Colorado USA
- Medical Department of Pediatrics University of Colorado Aurora Colorado USA
| | - Larry J. Dumont
- Vitalant Research Institute Denver Colorado USA
- Department of Pathology and Laboratory Medicine University of Colorado Medical School Aurora Colorado USA
| | - Kyle Annen
- Department of Pathology University of Colorado Aurora Colorado USA
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3
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Post-Hematopoietic Stem Cell Transplantation Immune-Mediated Anemia: A Literature Review and Novel Therapeutics. Blood Adv 2021; 6:2707-2721. [PMID: 34972204 PMCID: PMC9043947 DOI: 10.1182/bloodadvances.2021006279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/23/2021] [Indexed: 01/19/2023] Open
Abstract
Anemia after allogeneic hematopoietic stem cell transplantation (HSCT) can be immune or non–immune mediated. Auto- or alloimmunity resulting from blood group incompatibility remains an important cause in post-HSCT immune-mediated anemia. ABO incompatibility is commonly encountered in HSCT and may lead to serious clinical complications, including acute hemolysis, pure red cell aplasia, and passenger lymphocyte syndrome. It remains controversial whether ABO incompatibility may affect HSCT outcomes, such as relapse, nonrelapse mortality, graft-versus-host disease, and survival. Non-ABO incompatibility is less frequently encountered but can have similar complications to ABO incompatibility, causing adverse clinical outcomes. It is crucial to identify the driving etiology of post-HSCT anemia in order to prevent and treat this condition. This requires a comprehensive understanding of the mechanism of anemia in blood group–incompatible HSCT and the temporal association between HSCT and anemia. In this review, we summarize the literature on post-HSCT immune-mediated anemia with a focus on ABO and non-ABO blood group incompatibility, describe the underlying mechanism of anemia, and outline preventive and treatment approaches.
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4
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Hematologically important mutations: X-linked chronic granulomatous disease (fourth update). Blood Cells Mol Dis 2021; 90:102587. [PMID: 34175765 DOI: 10.1016/j.bcmd.2021.102587] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/01/2023]
Abstract
Chronic granulomatous disease (CGD) is an immunodeficiency disorder affecting about 1 in 250,000 individuals. CGD patients suffer from severe bacterial and fungal infections. The disease is caused by a lack of superoxide production by the leukocyte enzyme NADPH oxidase. Superoxide and subsequently formed other reactive oxygen species (ROS) are instrumental in killing phagocytosed micro-organisms in neutrophils, eosinophils, monocytes and macrophages. The leukocyte NADPH oxidase is composed of five subunits, of which the enzymatic component is gp91phox, also called Nox2. This protein is encoded by the CYBB gene on the X chromosome. Mutations in this gene are found in about 70% of all CGD patients in Europe and in about 20% in countries with a high ratio of parental consanguinity. This article lists all mutations identified in CYBB and should therefore help in genetic counseling of X-CGD patients' families. Moreover, apparently benign polymorphisms in CYBB are also given, which should facilitate the recognition of disease-causing mutations. In addition, we also include some mutations in G6PD, the gene on the X chromosome that encodes glucose-6-phosphate dehydrogenase, because inactivity of this enzyme may lead to shortage of NADPH and thus to insufficient activity of NADPH oxidase. Severe G6PD deficiency can induce CGD-like symptoms.
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5
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Lhomme F, Peyrard T, Babinet J, Abou-Chahla W, Durieu I, Moshous D, Neven B, Rohrlich PS, Albinni S, Amiranoff D, Dumont MD, Lortholary O, Héritier S, Marguet C, Suarez F, Fischer A, Blanche S, Hermine O, Mahlaoui N. Chronic Granulomatous Disease with the McLeod Phenotype: a French National Retrospective Case Series. J Clin Immunol 2020; 40:752-762. [PMID: 32562208 DOI: 10.1007/s10875-020-00791-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND X-linked chronic granulomatous disease (CGD) is a primary immunodeficiency caused by mutations in the CYBB gene (located on Xp21.1). Patients with large deletions on chromosome Xp21.1 can present with the McLeod phenotype and also Duchenne muscular dystrophy or retinitis pigmentosa. The objective of the present study was to describe a series of French patients with CGD and the McLeod phenotype. METHODS We retrospectively collected data from the medical records of 8 patients with CGD and the McLeod phenotype registered at the French National Reference Center for blood types. RESULTS The median age at diagnosis of CGD was 1.2 years, the median age at diagnosis of the McLeod phenotype was 4.5 years, and the median length of follow-up was 15.2 years. Four patients displayed allo-immunization, with anti-KEL20 and anti-XK1 (formerly known as anti-KL) antibodies. Five of the 6 patients with available blood smears had acanthocytosis. Neuropsychiatric, muscle-related, and ocular manifestations were present in 4, 2, and 1 of the patients, respectively. Three of the 4 patients having undergone allogeneic hematopoietic stem cell transplantation (HSCT) are alive. Overall, 5 patients are alive, and 3 are alive and well. CONCLUSION This is the largest yet descriptive study of a series of patients with X-linked CGD and the McLeod phenotype. Although this disease combination is rare, the timely, accurate diagnosis of the McLeod phenotype is critical because of the serious post-transfusion complications. However, HSCT can be considered in these patients.
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Affiliation(s)
| | - Thierry Peyrard
- Département Centre National de Référence pour les Groupes Sanguins (CNRGS), Institut national de la transfusion sanguine (INTS), 75522, Paris, Cedex 11, France.,UMR_S1134 Inserm, Université de Paris, 75015, Paris, France.,Laboratory of Excellence of Red Cells (GRex), Institut Imagine, 75015, Paris, France
| | - Jérôme Babinet
- Département Centre National de Référence pour les Groupes Sanguins (CNRGS), Institut national de la transfusion sanguine (INTS), 75522, Paris, Cedex 11, France
| | | | - Isabelle Durieu
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center, Hospices Civils de Lyon, Lyon, France.,EA HESPER 7425, Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Despina Moshous
- Pediatric Immuno-Hematology and Rheumatology Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France.,Sorbonne Paris Cité, Imagine Institute, Paris Descartes University, Paris, France
| | - Bénédicte Neven
- Pediatric Immuno-Hematology and Rheumatology Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France.,Sorbonne Paris Cité, Imagine Institute, Paris Descartes University, Paris, France
| | | | - Souha Albinni
- Établissement français du sang, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants malades University Hospital, Paris, France
| | - Denise Amiranoff
- Établissement français du sang, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants malades University Hospital, Paris, France
| | - Marie-Dominique Dumont
- Établissement français du sang, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants malades University Hospital, Paris, France
| | - Olivier Lortholary
- Sorbonne Paris Cité, Imagine Institute, Paris Descartes University, Paris, France.,Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France
| | - Sébastien Héritier
- Department of Pediatric Hematology and Oncology, Assistance Publique-Hôpitaux de Paris (AP-HP), Trousseau Hospital, Sorbonne University Medical School, Paris, France
| | | | - Felipe Suarez
- Department of Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France.,INSERM UMR 1163, CNRS ERL 8254, Imagine Institute, Sorbonne Paris Cité, Paris Descartes University, Paris, France.,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France
| | - Alain Fischer
- Pediatric Immuno-Hematology and Rheumatology Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France.,Sorbonne Paris Cité, Imagine Institute, Paris Descartes University, Paris, France.,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France.,Collège de France, Paris, France
| | - Stéphane Blanche
- Pediatric Immuno-Hematology and Rheumatology Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France.,Sorbonne Paris Cité, Imagine Institute, Paris Descartes University, Paris, France.,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France
| | - Olivier Hermine
- Laboratory of Excellence of Red Cells (GRex), Institut Imagine, 75015, Paris, France.,Department of Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France.,INSERM UMR 1163, CNRS ERL 8254, Imagine Institute, Sorbonne Paris Cité, Paris Descartes University, Paris, France.,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France
| | - Nizar Mahlaoui
- Pediatric Immuno-Hematology and Rheumatology Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France. .,Sorbonne Paris Cité, Imagine Institute, Paris Descartes University, Paris, France. .,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Assistance Publique-Hôpitaux de Paris (AP-HP), Necker-Enfants Malades University Hospital, Paris, France.
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6
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Roulis E, Hyland C, Flower R, Gassner C, Jung HH, Frey BM. Molecular Basis and Clinical Overview of McLeod Syndrome Compared With Other Neuroacanthocytosis Syndromes. JAMA Neurol 2018; 75:1554-1562. [DOI: 10.1001/jamaneurol.2018.2166] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Eileen Roulis
- Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Catherine Hyland
- Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Robert Flower
- Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - Christoph Gassner
- Blood Transfusion Service Zurich, Swiss Red Cross, Schlieren/Zürich, Switzerland
| | - Hans H. Jung
- Department of Neurology, University and University Hospital Zurich, Zurich, Switzerland
| | - Beat M. Frey
- Blood Transfusion Service Zurich, Swiss Red Cross, Schlieren/Zürich, Switzerland
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7
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Connelly JA, Marsh R, Parikh S, Talano JA. Allogeneic Hematopoietic Cell Transplantation for Chronic Granulomatous Disease: Controversies and State of the Art. J Pediatric Infect Dis Soc 2018; 7:S31-S39. [PMID: 29746680 PMCID: PMC5946867 DOI: 10.1093/jpids/piy015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic granulomatous disease (CGD) is a congenital disorder characterized by recurrent life-threatening bacterial and fungal infections and development of severe inflammation secondary to a congenital defect in 1 of the 5 phagocyte oxidase (phox) subunits of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. Hematopoietic cell transplant (HCT) is a curative treatment for patients with CGD that provides donor neutrophils with functional NADPH and superoxide anion production. Many characteristics of CGD, including preexisting infection and inflammation and the potential for cure with mixed-donor chimerism, influence the transplant approach and patient outcome. Because of the dangers of short-term death, graft-versus-host disease, and late effects from chemotherapy, HCT historically has been reserved for patients with high-risk disease and a matched donor. However, as advances in CGD and HCT treatments have evolved, recommendations on transplant eligibility also must be amended, but the development of modern guidelines has proven difficult. In this review, we provide an overview of HCT in patients with CGD, including the debate over HCT indications in them, the unique aspects of CGD that can complicate HCT, and a summary of transplant outcomes.
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Affiliation(s)
- James A Connelly
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital, Ohio
| | - Suhag Parikh
- Division of Pediatric Blood and Marrow Transplantation, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Julie-An Talano
- Division of Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee,Correspondence: J. A. Connelly, MD, Division of Pediatric Hematology/Oncology, Vanderbilt University Medical Center, 397 PRB, 2220 Pierce Ave, Nashville, TN 37232-6310 ()
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8
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Neurodegeneration in the elderly – When the blood type matters: An overview of the McLeod syndrome with focus on hematological features. Transfus Apher Sci 2015; 52:277-84. [DOI: 10.1016/j.transci.2015.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Successful stem cell transplantation in a child with chronic granulomatous disease associated with contiguous gene deletion syndrome and complicated by macrophage activation syndrome. Clin Immunol 2014; 154:112-5. [PMID: 25063445 DOI: 10.1016/j.clim.2014.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/07/2014] [Accepted: 07/16/2014] [Indexed: 11/20/2022]
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10
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Güngör T, Teira P, Slatter M, Stussi G, Stepensky P, Moshous D, Vermont C, Ahmad I, Shaw PJ, Telles da Cunha JM, Schlegel PG, Hough R, Fasth A, Kentouche K, Gruhn B, Fernandes JF, Lachance S, Bredius R, Resnick IB, Belohradsky BH, Gennery A, Fischer A, Gaspar HB, Schanz U, Seger R, Rentsch K, Veys P, Haddad E, Albert MH, Hassan M. Reduced-intensity conditioning and HLA-matched haemopoietic stem-cell transplantation in patients with chronic granulomatous disease: a prospective multicentre study. Lancet 2014; 383:436-48. [PMID: 24161820 DOI: 10.1016/s0140-6736(13)62069-3] [Citation(s) in RCA: 259] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND In chronic granulomatous disease allogeneic haemopoietic stem-cell transplantation (HSCT) in adolescents and young adults and patients with high-risk disease is complicated by graft-failure, graft-versus-host disease (GVHD), and transplant-related mortality. We examined the effect of a reduced-intensity conditioning regimen designed to enhance myeloid engraftment and reduce organ toxicity in these patients. METHODS This prospective study was done at 16 centres in ten countries worldwide. Patients aged 0-40 years with chronic granulomatous disease were assessed and enrolled at the discretion of individual centres. Reduced-intensity conditioning consisted of high-dose fludarabine (30 mg/m(2) [infants <9 kg 1·2 mg/kg]; one dose per day on days -8 to -3), serotherapy (anti-thymocyte globulin [10 mg/kg, one dose per day on days -4 to -1; or thymoglobuline 2·5 mg/kg, one dose per day on days -5 to -3]; or low-dose alemtuzumab [<1 mg/kg on days -8 to -6]), and low-dose (50-72% of myeloablative dose) or targeted busulfan administration (recommended cumulative area under the curve: 45-65 mg/L × h). Busulfan was administered mainly intravenously and exceptionally orally from days -5 to -3. Intravenous busulfan was dosed according to weight-based recommendations and was administered in most centres (ten) twice daily over 4 h. Unmanipulated bone marrow or peripheral blood stem cells from HLA-matched related-donors or HLA-9/10 or HLA-10/10 matched unrelated-donors were infused. The primary endpoints were overall survival and event-free survival (EFS), probabilities of overall survival and EFS at 2 years, incidence of acute and chronic GVHD, achievement of at least 90% myeloid donor chimerism, and incidence of graft failure after at least 6 months of follow-up. FINDINGS 56 patients (median age 12·7 years; IQR 6·8-17·3) with chronic granulomatous disease were enrolled from June 15, 2003, to Dec 15, 2012. 42 patients (75%) had high-risk features (ie, intractable infections and autoinflammation), 25 (45%) were adolescents and young adults (age 14-39 years). 21 HLA-matched related-donor and 35 HLA-matched unrelated-donor transplants were done. Median time to engraftment was 19 days (IQR 16-22) for neutrophils and 21 days (IQR 16-25) for platelets. At median follow-up of 21 months (IQR 13-35) overall survival was 93% (52 of 56) and EFS was 89% (50 of 56). The 2-year probability of overall survival was 96% (95% CI 86·46-99·09) and of EFS was 91% (79·78-96·17). Graft-failure occurred in 5% (three of 56) of patients. The cumulative incidence of acute GVHD of grade III-IV was 4% (two of 56) and of chronic graft-versus-host disease was 7% (four of 56). Stable (≥90%) myeloid donor chimerism was documented in 52 (93%) surviving patients. INTERPRETATION This reduced-intensity conditioning regimen is safe and efficacious in high-risk patients with chronic granulomatous disease. FUNDING None.
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Affiliation(s)
- Tayfun Güngör
- University Children's Hospital, Division of Blood and Marrow Transplantation, Zurich, Switzerland.
| | - Pierre Teira
- Centre de Recherche du CHU Sainte-Justine, Département de Pédiatrie, Université de Montréal, Montréal, QC, Canada
| | - Mary Slatter
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Georg Stussi
- University Hospital, Division of Hematology and Blood and Marrow Transplantation, Zürich, Switzerland
| | - Polina Stepensky
- Hadassah Hebrew University Medical Center, Department of Blood and Marrow Transplantation, Jerusalem, Israel
| | - Despina Moshous
- AP-HP, Hôpital Necker Enfants Malades, Paediatric Immunology, Sorbonne Paris Cité, Université Paris Descartes, Imagine Institute, Paris, France
| | - Clementien Vermont
- Leiden University Medical Center, Department of Paediatrics, Leiden, Netherlands
| | - Imran Ahmad
- Blood and Marrow Transplantation Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Peter J Shaw
- Children's Hospital, Division of Blood and Marrow Transplantation, Westmead, Sydney, NSW, Australia
| | | | - Paul G Schlegel
- University Children's Hospital, Division of Blood and Marrow Transplantation, Würzburg, Germany
| | - Rachel Hough
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anders Fasth
- Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden
| | - Karim Kentouche
- Department of Paediatrics, Jena University Hospital, Jena, Germany
| | - Bernd Gruhn
- Department of Paediatrics, Jena University Hospital, Jena, Germany
| | | | - Silvy Lachance
- Blood and Marrow Transplantation Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Robbert Bredius
- Leiden University Medical Center, Department of Paediatrics, Leiden, Netherlands
| | - Igor B Resnick
- Hadassah Hebrew University Medical Center, Department of Blood and Marrow Transplantation, Jerusalem, Israel
| | | | - Andrew Gennery
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Alain Fischer
- AP-HP, Hôpital Necker Enfants Malades, Paediatric Immunology, Sorbonne Paris Cité, Université Paris Descartes, Imagine Institute, Paris, France
| | - H Bobby Gaspar
- Great Ormond Street Children's Hospital, Division of Blood and Marrow Transplantation, London, UK; Molecular Immunology Unit; UCL Institute of Child Health, London, UK
| | - Urs Schanz
- University Hospital, Division of Hematology and Blood and Marrow Transplantation, Zürich, Switzerland
| | - Reinhard Seger
- University Children's Hospital, Division of Blood and Marrow Transplantation, Zurich, Switzerland
| | - Katharina Rentsch
- University Hospital, Divison of Clinical Chemistry, KFC, Novum, Laboratory Medicine, Karolinska University Hospital-Huddinge Stockholm, Sweden
| | - Paul Veys
- Great Ormond Street Children's Hospital, Division of Blood and Marrow Transplantation, London, UK; Molecular Immunology Unit; UCL Institute of Child Health, London, UK
| | - Elie Haddad
- Centre de Recherche du CHU Sainte-Justine, Département de Pédiatrie, Université de Montréal, Montréal, QC, Canada
| | | | - Moustapha Hassan
- Division of Experimental Cancer Medicine, KFC, Novum, Laboratory Medicine, Karolinska University Hospital-Huddinge Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden
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11
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Kang EM, Marciano BE, DeRavin S, Zarember KA, Holland SM, Malech HL. Chronic granulomatous disease: overview and hematopoietic stem cell transplantation. J Allergy Clin Immunol 2011; 127:1319-26; quiz 1327-8. [PMID: 21497887 DOI: 10.1016/j.jaci.2011.03.028] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/23/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
Abstract
Chronic granulomatous disease (CGD) still causes significant morbidity and mortality. The difficulty in considering high-risk yet curative treatments, such as allogeneic bone marrow transplantation, lies in the unpredictable courses of both CGD and bone marrow transplantation in different patients. Some patients with CGD can have frequent infections, granulomatous or autoimmune disorders necessitating immunosuppressive therapy, or both but also experience long periods of relative good health. However, the risk of death is clearly higher in patients with CGD of all types, and the complications of CGD short of death can still cause significant morbidity. Therefore, with recent developments and improvements, bone marrow transplantation, previously considered an experimental or high-risk procedure, has emerged as an important option for patients with CGD. We will discuss the complications of CGD that result in significant morbidity and mortality, particularly the most common infections and autoimmune/inflammatory complications, as well as their typical management. We will then discuss the status of bone marrow transplantation.
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Affiliation(s)
- Elizabeth M Kang
- Laboratory of Host Defenses, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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12
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Hematopoietic stem cell transplantation for chronic granulomatous disease. Immunol Allergy Clin North Am 2010; 30:195-208. [PMID: 20493396 DOI: 10.1016/j.iac.2010.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency disease that is caused by the lack of 1 of 5 subunits of the superoxide-producing nicotinamide adenine dinucleotide phosphate oxidase of neutrophils, macrophages, and eosinophils. Allogeneic hematopoietic stem cell transplantation (HSCT) is currently the only curative treatment for CGD and can be offered to selected patients. Improved outcome with supportive care and high clinical variability in the disease course, however, make selection of eligible patients for HSCT difficult. This article addresses recent progress in HSCT for CGD, delineates present limitations, and points to future developments.
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RH genotyping in a sickle cell disease patient contributing to hematopoietic stem cell transplantation donor selection and management. Blood 2010; 116:2836-8. [PMID: 20644109 DOI: 10.1182/blood-2010-04-279372] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
African individuals harbor molecular RH variants, which permit alloantibody formation to high-prevalence Rh antigens after transfusions. Genotyping identifies such RH variants, which are often missed by serologic blood group typing. Comprehensive molecular blood group analysis using 3 genotyping platforms, nucleotide sequencing, and serologic evaluation was performed on a 7-year-old African male with sickle cell disease who developed an "e-like" antibody shortly after initiating monthly red blood cell (RBC) transfusions for silent stroke. Genotyping of the RH variant predicted a severe shortage of compatible RBCs for long-term transfusion support, which contributed to the decision for hematopoetic stem cell transplantation. RH genotyping confirmed the RH variant in the human leukocyte antigen-matched sibling donor. The patient's (C)ce(s) type 1 haplotype occurs in up to 11% of African American sickle cell disease patients; however, haplotype-matched RBCs were serologically incompatible. This case documents that blood unit selection should be based on genotype rather than one matching haplotype.
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